As the dust settled following the Supreme Court’s 5-4 decision to uphold the Patient Protection and Affordable Care Act, panelists at a June 29 National Press Club Newsmaker said some consumer confusion is sure to follow and cautioned that the legal wrangling may not be over.

A representative from a community-based health care provider and an integrated health care insurer both expressed relief that the law was upheld, but Jenny Englerth, executive director and chief executive officer of Family First Health in Central Pennsylvania, said consumers are going to be confused.

People move between a variety of health care systems from employer-based insurance, to private insurance to public insurance and public systems and may not know how the ruling affects their options, Englerth said.

Most of the confusion is due to the difference between patient experience and health care outcomes, said Paul Keckley, executive director of Deloitte Center for Health Solutions. “The public thinks they are one in the same,” he said.

The Affordable Care Act assumes that everyone needs to be led instead of patients acting like consumers, Keckley complained.

The court’s decision alleviated uncertainty for Michael M. Dudley, president and chief executive officer of Optima Health Plan and senior vice president of Sentara Healthcare. His company has been “implementing the required aspects at the required time” but with no assurance that the requirements would remain, Dudley said.

The certainty that Dudley seeks may not be real, warned Colin Roskey, a partner at the Alston & Bird law firm.

In upholding the law, the court said the penalties imposed on people that do not purchase health insurance amount to a tax. This could lead to another legal challenge, Roskey said, noting that according to the Constitution, tax bills must originate in the House of Representatives, but the House passed the Senate bill so it may be invalid. He later said he didn’t think there would be enough votes in the Senate to repeal the bill even if the Republicans win the majority.

The court’s decision will now force the states to begin implementing the health care exchanges that must be ready before Oct. 1, 2013, said Dan Maynard, president of Connecture, a company that operates exchanges. He noted that the Friday after the November election, Nov. 16, 2012, is the day that states must certify their plans for meeting the October 2013 deadline to the federal government. States that have been waiting to find out if the law was unconstitutional need to “stop procrastinating” he said.

With or without the law, people are living longer and are participating in more health care, said Atul Grover, chief public policy officer of the American Association of Medical Colleges.

“We are a victim our own success,” Grover said, noting as one example that childhood leukemia is now generally survivable so that person continues to partake of health care for decades longer than someone contracting the disease a generation ago.